Polycystic Ovary Syndrome (PCOS) is a common hormonal and metabolic condition that affects people with ovaries during reproductive years. It disrupts normal ovulation and raises androgen levels. Symptoms vary widely. Early recognition improves long-term outcomes.

Why PCOS matters

PCOS affects reproductive health, metabolic function, and mental well-being. It raises risks for type 2 diabetes, heart disease, pregnancy complications, and mood disorders. Therefore, timely diagnosis and sustained care matter.

What causes PCOS — succinct pathophysiology

PCOS arises from a mix of genetic predisposition and metabolic triggers. Insulin resistance often plays a central role. High insulin increases ovarian androgen production. In turn, excess androgens interfere with follicle maturation. Low-grade inflammation and altered gonadotropin signaling (LH:FSH imbalance) also contribute. In short, PCOS is multi-factorial: metabolic, hormonal, and genetic factors interact.

Core diagnostic criteria (practical rule)

Clinicians commonly use the Rotterdam criteria. You meet the diagnosis when at least two of three are present: (1) irregular or absent ovulation, (2) clinical or biochemical signs of high androgens, (3) polycystic ovarian morphology on ultrasound. Importantly, doctors exclude other causes first, such as thyroid disease, hyperprolactinemia, and congenital adrenal hyperplasia.

Common symptoms to watch for

• Irregular periods or no periods.
• Heavy or light menstrual flow.
• Excess facial or body hair (hirsutism).
• Acne or oily skin.
• Thinning scalp hair.
• Weight gain or difficulty losing weight.
• Fatigue and low mood.
• Difficulty conceiving. Symptoms differ by person and may change with age.

Key tests clinicians order

• Blood tests: free testosterone, SHBG, DHEA-S, LH, FSH, TSH, prolactin, fasting glucose and insulin, lipid profile.
• Oral glucose tolerance test (OGTT) if insulin resistance suspected.
• Pelvic ultrasound to assess ovarian morphology.
• Consider adrenal testing if DHEA-S markedly raised. Test choices depend on age, symptoms, and fertility goals.

Distinguishing PCOS from other conditions

Rule out thyroid dysfunction, hyperprolactinemia, nonclassical congenital adrenal hyperplasia, Cushing’s syndrome, and androgen-secreting tumors. In practice, labs and clinical red flags guide further evaluation. Sudden severe symptoms or very high androgen levels require urgent specialist assessment.

Short-term and long-term health risks

Short term: menstrual irregularity and infertility. Long term: type 2 diabetes, dyslipidemia, hypertension, sleep apnea, endometrial hyperplasia, and cardiovascular disease. Also, PCOS increases the risk of anxiety and depression. Therefore, address both metabolic and mental health.

Treatment goals — what to prioritise

Treatment focuses on three goals: regulate cycles and reduce symptoms, manage metabolic risk, and support fertility when desired. Care should tailor to age, symptoms, medical risks, and personal priorities.

First-line management: lifestyle changes

Start with lifestyle. Even modest weight loss (5–10% body weight) improves insulin sensitivity, monthly cycles, and fertility. Aim for regular physical activity (150 minutes per week minimum). Prefer whole foods, limit refined carbs, and prioritize protein and fiber. Sleep and stress management matter. Use gradual, sustainable changes rather than restrictive diets.

Medical treatments — symptom-based choices

• Combined oral contraceptives regulate periods and lower androgens.
• Progestin therapy prevents endometrial overgrowth when cycles stay absent.
• Metformin improves insulin sensitivity and may restore cycles.
• Anti-androgens (spironolactone, finasteride) reduce hirsutism and acne but need contraception in people of childbearing potential.
• Topical or dermatologic therapies treat acne and hair. Use them with systemic therapy for best results.

Fertility-directed care

If you want pregnancy, clinicians usually start with lifestyle plus ovulation induction. First options include letrozole (preferred) or clomiphene citrate. If these fail, add injectable gonadotropins or consider assisted reproduction (IVF). During pregnancy, monitor glucose closely because PCOS increases gestational diabetes risk.

Metabolic screening and prevention

Screen routinely for insulin resistance, prediabetes, diabetes, dyslipidemia, and blood pressure changes. Repeat screening every 1–3 years depending on baseline risk. Intervene early with diet, exercise, and medications when indicated.

Mental health and quality of life

PCOS can lower self-esteem and raise anxiety and depression rates. Screen for mood disorders. Offer counseling, peer support, or cognitive behavioral therapy. Address body image and sexual health openly.

Practical daily plan (simple, realistic)

• Move daily: combine walking, strength training, and interval work.
• Eat regular meals with protein and fiber; reduce sugary drinks and refined snacks.
• Sleep 7–9 hours and keep a regular schedule.
• Track periods and symptoms to share with your clinician.
• Seek support groups or a counsellor for emotional load.

When to see a doctor urgently

See urgent care or a specialist if you experience sudden deepening of voice, rapid hair growth, unexplained severe pelvic pain, very irregular bleeding, or pregnancy complications. Otherwise, schedule a primary care or gynecology visit for evaluation and planning.

Prognosis and outlook

With treatment, many people with PCOS achieve regular cycles, symptom control, and healthy pregnancies. Long-term metabolic risks reduce with sustained lifestyle changes and medical care. In short, PCOS is manageable but requires ongoing attention.

Key takeaways — what to remember

PCOS combines reproductive and metabolic features. Insulin resistance often drives symptoms. Diagnosis uses clinical criteria plus tests. Start with lifestyle changes. Use medication for symptoms or fertility needs. Screen for metabolic and mental-health risks. Stay consistent with follow-up.

PCOS affects the body and mind. You are not to blame. Small, steady steps make a big difference. Ask for help. Use trusted clinicians and support networks. If you want, I will create: a 4-week meal and exercise plan, a checklist for clinic visits, or a patient-friendly infographic. Which would help you most?